Behavioral Health Qualified Directed Payments

A uniform percent increase in reimbursement rates to qualified behavioral health participating/contracted providers. This increase is in addition to CCO contracted rates already in place effective in January 2022 and limited to the following covered services:  Assertive Community Treatment (ACT), Supported Employment Services (SE), Outpatient Mental Health Treatment and Services (OP MH), and Outpatient and Non-inpatient withdrawal management Substance Use Disorder Treatment and Services (OP SUD). The increased percentage has two tiers based on the details of a provider’s total patient service revenue:

• Tier 2 “Primarily Medicaid” – defined as having at least 50% of its total patient service revenue derived from providing Medicaid services in the prior calendar year.
• Tier 1 “Primarily Non-Medicaid” – defined as having less than 50% of its total patient service revenue from providing Medicaid services in the prior calendar year.

How Do Providers Get Paid the Increased Rate?

• All qualified participating providers who held a contract on or after January 1, 2022, will automatically receive the Tier 1 “Primarily Non-Medicaid” rate increases incorporated into the CareOregon Fee Schedule.  If a qualified participating provider meets criteria for the Tier 2 “Primarily Medicaid” rate increase, the provider must provide documentation demonstrating criteria is met based on the BH revenue from Medicaid services provided in the previous calendar year.
• Fill out the OHA’s Primarily Medicaid Provider Attestation form, available on the Oregon.gov website.  Completed forms are to be submitted through a secure email to CareOregon at BH_attest@careoregon.org.

A uniform payment increase for qualified behavioral health providers certified by OHA for integrated treatment of Integrated Co-Occurring Disorders (ICD) rendered by qualified staff per OAR 309-019-0145. This increase is in addition to CCO contracted rates already in place and any other tiered payment and/or CLSS QDP rate increases.

Which Providers Qualify?

• To qualify for the ICD rate increase, a provider must be approved by the OHA to provide ICD services. Please refer to the OHA’s ICD webpage for details, including a list of approved ICD programs.

How Do Providers Get Paid the Increased Rate?

• Providers do not need to notify us of your ICD designation.
• All ICD claims must contain at least 2 OHA ICD approved diagnoses. Please refer to the OHA’s ICD Billing Guide for these details.
• ICD claims must include ICD modifiers as appropriate, but do not add a second detail line for these modifiers when billing CareOregon.
• HH: Integrated Co-Occurring Disorders (ICD) Program, services rendered by QMHAs, Peer Support Specialists and SUD treatment staff. ICD claims must contain at least 2 OHA approved ICD diagnoses.
• HO: Integrated Co-Occurring Disorders (ICD) Program, services rendered by QMHPs, LMPs, and Mental Health Interns. ICD claims must contain at least 2 OHA ICD approved diagnoses.
• U2: Integrated Co-Occurring Disorders (ICD) Residential Treatment services. ICD claims must contain at least 2 OHA ICD approved diagnoses.

A uniform payment increase to qualified behavioral health participating/contracted providers who deliver culturally and/or linguistically specific services (CLSS) as defined by the Oregon Administrative Rules (OARs). This increase is in addition to CCO contracted rates already in place  and any tiered payment and/or ICD QDP rate increases. Payment increases are available based on “Rural” and “Non-Rural” classifications.

Which Providers Qualify?

• CLSS organizations and programs, individuals, and bilingual service and sign language providers enrolled as a Medicaid provider and meet criteria defined in OAR Chapter 309, Division 65 and provide the following services:
• Assertive Community Treatment (ACT)
• Supported Employment Services (SE)
• Applied Behavior Analysis (ABA)
• Wraparound
• Outpatient Mental Health Treatment and Services (OP MH)
• Outpatient Substance Use Disorder Treatment and Services (OP SUD) and non-Inpatient withdrawal management

How Do Providers Get Paid the Increased Rate?

For providers designated as follows by the OHA (per their online approved-provider list):

• CLSS Programs (459)
• CLSS Organizations (460)
• CLSS Individual Providers (461)
• Individual Bilingual Providers (462)
• Individual Sign Language Provider (463)
• You do not need to notify us of your CLSS designation.
• CLSS claims must include CLSS modifiers as appropriate. Please refer to the CareOregon Fee Schedule and OHA’s CLSS Billing Guidefor these details. Please note: Care Oregon’s claim processing system cannot accurately process CLSS claims when two lines of modifier are billed a stated in the OHA Billing Guide. Please bill your CPT code and CLSS modifier on one line.
  • U9: Culturally and Linguistically Specific Services for non-rural providers
  • TN: Culturally and Linguistically Specific Services for rural providers

Regardless of a provider’s contract status with a CCO, effective January 1, 2023, the Oregon Health Authority requires CCOs to reimburse qualified providers of Substance Use Disorders (SUD) Residential services, Applied Behavior Analysis (ABA) and Mental Health Children’s Wraparound services at rates that are no less than OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service.

Which Providers Qualify?

• The directed payment is limited to Medicaid covered SUD Residential, Applied Behavior Analysis, and MH Children’s Wraparound services.

How Do Providers Get Paid?

• All qualified providers will receive payment no less than OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service.

CareOregon's Noncontracted Fee Schedule

You may review CareOregon's Noncontracted MH & SUD metro BH fee schedule.